Complete this form to receive a Return Material Authorization (RMA) number. Please provide a purchase order number (purchase order value not to exceed $500 for circuit boards or $4000 for analyzers). You will receive an RMA # within 24 hours of receipt of this form.

Company Billing Address
Company Shipping Address
Leave this section blank if your shipping and billing information are the same.
Contact Person
RMA Information
Circuit boards not to exceed $500 each. Analyzers not to exceed $3500 each.
If shipping FedEx or UPS, please provide your account number.

If repair cost will exceed PO value , an amended PO may be needed. A CIC Representative will contact you at that time to review all options.